White Spot Lesion Treatment Options: A Systematic Review of Different Techniques for Masking These Lesions
Abstract
1. Introduction
2. Methods
2.1. Study Sources
2.2. Search Strategy
3. Results
3.1. Characteristics of the Studies
3.2. Risk of Bias Analysis
4. Discussion
4.1. Remineralizing Gels
4.2. Fluoride Gel Therapies
4.3. Ozone, Fluoride, and Octenidine
4.4. Resin Infiltration and Fluoride Varnish
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
WSLs | White Spot Lesions |
CPP-ACP | Casein Phosphopeptide–Amorphous Calcium Phosphate |
ICDAS | International Caries Detection and Assessment System |
ECM | Electronic Caries Monitor |
QLF | Quantitative Light-Induced Fluorescence |
TEGDMA | Triethylene Glycol Dimethacrylate |
DEJ | Dentin–Enamel Junction |
MI Paste Plus | Casein Phosphopeptide–Amorphous Calcium Phosphate with Fluoride |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
RCT | Randomized Clinical Trial |
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Author/
Year |
Study
Design |
Participants
(nr/age) | Intervention Time | Treatment Techniques in Study | Results | Conclusions |
---|---|---|---|---|---|---|
Mennatallah Atef Aboulnaga et al., 2022 [37] | RCT | 40 participants, aged 15–25 | 3 months | Remin Pro (SF—1450 ppm, hydroxyapatite, xylitol) and Remin Pro Forte (SF—1450 ppm, hydroxyapatite, xylitol, ginger extracts, and curcuma) | Both were effective, with Remind Pro Forte showing superior performance. | The combination of additional bioactive ingredients, including ginger extracts and curcuma, in Remin Pro Forte provides enhanced remineralization, making it more effective for managing WSLs. |
Peter Rechmann et al., 2017 [42] | RCT | 40 participants, age range 11–26 years | 12 months | Experimental group: twice-daily fluoride toothpaste, daily MI Paste Plus MIPP), quarterly MI Varnish (MIV) application | No significant differences in enamel decalcification or caries detection (ICDAS) scores between experimental and control groups at 12 months. | Varnish did not significantly reduce the incidence of WSLs during fixed orthodontic treatment. However, they delivered fluoride effectively. |
Grocholewicz et al., 2022 [34] | RCT | 150 patients, aged 16–50 years | 12 months | Fluoride varnish, ozone therapy, octenidine mouthrinse | Lower incidence of WSLs with combined treatment techniques. | Combination of fluoride varnish, ozone, and octenidine reduced WSLs compared to control group. |
Rai et al., 2016 [35] | Split-mouth randomized study | 45 children, age range 7–15 years | 9 months | Resin infiltration with or without chlorhexidine varnish | Slower progression of caries in test group (resin infiltration + chlorhexidine varnish). | Resin infiltration with chlorhexidine varnish over resin infiltration alone, improving caries control in more advanced lesions (ICDAS 3). |
Turska-Szybka et al., 2016 [43] | RCT | 81 children, 18–71 months | 1 year | Resin infiltration with fluoride varnish vs. fluoride varnish only | Significantly reduced progression of early caries lesions with resin infiltration. | Resin infiltration combined with fluoride varnish is more effective than fluoride varnish alone in arresting caries. |
Heravi et al., 2018 [38] | RCT | 36 participants (13–23 years) | 12 weeks | MI Paste Plus (containing CPP-ACPF), Remin Pro (containing hydroxyapatite and fluoride), control | Significant reduction in WSL area, increased mineral content, and improved aesthetics for MI Paste Plus and Remin Pro groups. | The combination of CPP-ACP and fluoride in MI Paste Plus, and hydroxyapatite, fluoride, and xylitol in Remin Pro provide effective remineralization and improved aesthetics for WSLs. |
Ebrahimi et al., 2017 [44] | RCT | 80 children (7–12 years) | 10 days | MI Paste Plus (containing CPP-ACPF), Remin Pro (containing hydroxyapatite and fluoride), 2% SF gel | All remineralizing agents significantly reduced the area and increased the mineral content of WSLs. The control group showed no significant improvement. | The combination of bioactive ingredients in MI Paste Plus and Remin Pro was as effective as 2% SF, making them suitable alternatives for managing WSLs in children. |
Güçlü et al., 2016 [45] | RCT | 21 children (8–15 years) | 12 weeks | Application of 10% CPP-ACP paste and 5% SF varnish | CPP-ACP and its combination with fluoride varnish significantly improved visual appearance and remineralization of WSLs. Fluoride varnish alone showed no additional advantage. | Twice-daily application of CPP-ACP significantly improves WSLs’ appearance and mineralization, making it effective as a standalone treatment. |
Study (Author, Year) | D1: | D2: | D3: | D4: | D5: | Overall Risk of Bias |
---|---|---|---|---|---|---|
Aboulnaga et al., 2022 [37] | 🟢 Low | 🟢 Low | 🟢 Low | 🟢 Low | 🟢 Low | 🟢 Low |
Rechmann et al., 2017 [42] | 🟢 Low | 🟢 Low | 🟡 Some Concerns | 🟢 Low | 🟡 Some Concerns | 🟢 Low |
Grocholewicz et al., 2022 [34] | 🟢 Low | 🟢 Low | 🟡 Some Concerns | 🟡 Some Concerns | 🟢 Low | 🟢 Low |
Rai et al., 2016 [35] | 🟢 Low | 🟢 Low | 🟢 Low | 🟢 Low | 🟢 Low | 🟢 Low |
Turska-Szybka et al., 2016 [43] | 🟢 Low | 🟢 Low | 🟢 Low | 🟡 Some Concerns | 🟡 Some Concerns | 🟢 Low |
Heravi et al., 2018 [38] | 🟡 Some Concerns | 🟢 Low | 🟢 Low | 🟡 Some Concerns | 🟢 Low | 🟢 Low |
Ebrahimi et al., 2017 [44] | 🟢 Low | 🟡 Some Concerns | 🟡 Some Concerns | 🟡 Some Concerns | 🟢 Low | 🟡 Some Concerns |
Güçlü et al., 2016 [45] | 🟢 Low | 🟢 Low | 🟡 Some Concerns | 🟢 Low | 🟢 Low | 🟢 Low |
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Lamorgese, M.; Veiga, N.; Correia, M.J.; Gomes, A.T.P.C.; Lopes, S.; Lopes-Rocha, L.; Fidalgo-Pereira, R.; Lopes, P.C. White Spot Lesion Treatment Options: A Systematic Review of Different Techniques for Masking These Lesions. Gels 2025, 11, 371. https://doi.org/10.3390/gels11050371
Lamorgese M, Veiga N, Correia MJ, Gomes ATPC, Lopes S, Lopes-Rocha L, Fidalgo-Pereira R, Lopes PC. White Spot Lesion Treatment Options: A Systematic Review of Different Techniques for Masking These Lesions. Gels. 2025; 11(5):371. https://doi.org/10.3390/gels11050371
Chicago/Turabian StyleLamorgese, Michela, Nélio Veiga, Maria J. Correia, Ana T. P. C. Gomes, Sara Lopes, Lígia Lopes-Rocha, Rita Fidalgo-Pereira, and Pedro C. Lopes. 2025. "White Spot Lesion Treatment Options: A Systematic Review of Different Techniques for Masking These Lesions" Gels 11, no. 5: 371. https://doi.org/10.3390/gels11050371
APA StyleLamorgese, M., Veiga, N., Correia, M. J., Gomes, A. T. P. C., Lopes, S., Lopes-Rocha, L., Fidalgo-Pereira, R., & Lopes, P. C. (2025). White Spot Lesion Treatment Options: A Systematic Review of Different Techniques for Masking These Lesions. Gels, 11(5), 371. https://doi.org/10.3390/gels11050371